Anthem and CommonSpirit on different pages regarding reimbursem*nt rates
By Melissa Henry, Lindsey Grewe and Cameron Dean
Published: Apr. 30, 2024 at 12:26 PM MDT|Updated: May. 1, 2024 at 7:51 AM MDT
COLORADO SPRINGS, Colo. (KKTV) - Since the deadline Tuesday at midnight, Anthem and Commonspirit have been unable to be on the same page during their negotiations.
CommonSpirit proposed a temporary contract that would last while negotiations continued to continue service to patients insured under Anthem- but Anthem declined that offer.
Now thousands of people will be paying more out of pocket to continue services at certain primary care facilities. Those with special procedures and surgeries have until May 10 before their coverage expires.
According to Anthem, if they were to agree to CommonSpirit’s terms it would raise costs for its members and their employers. In a statement to 11 news they said in part:
“CommonSpirit has established a pattern of disrupting care for its patients as a negotiation tactic to demand unreasonable price hikes for consumers and employers. This is the same pattern CommonSpirit recently used in Arizona, California, and Nevada – leaving other health plans’ networks for as long as 45 days to pressure them into agreeing to exceptional cost increases.”
CommonSpirit says their rates are to best support the patients they have and now they’re worried about how these negotiations may affect them.
" She’s actually praying for these negotiations to cease so that we can get a contract quickly because she’s so worried about having any of her care disrupted through this process. Patients shouldn’t have to go through that. Patients should be able to see who they want and be able to get the care from the people they trust; that’s not happening right now,” said a doctor with CommonSpirit, Dr. Oswaldo Grenardo.
Whatever that decision ultimately is will impact thousands of Coloradans.
The challenge to reach an agreement stems from the reimbursem*nt rate the insurance company and the provider have to agree upon. CommonSpirit leadership says Anthem is offering rates that are too low, while Anthem says CommonSpirit’s prices are simply too high.
Part of Anthem’s statement on the matter reads, “For many years, Anthem Blue Cross and Blue Shield (Anthem) members have been able to receive in-network care from CommonSpirit Health (formerly part of Centura Health). Unfortunately, CommonSpirit Health has become one of the more expensive health systems in Colorado ... Agreement negotiations are a normal course of business; however, CommonSpirit’s tactics are not normal. CommonSpirit has informed us that if we do not agree to reimbursem*nt rate increases more than twice the rate of inflation, they will leave our health plan networks starting May 1, 2024.”
According to Anthem...
- Emergency room rates at CommonSpirit mountain and rural facilities are 232 % higher than all other nearby health systems.
- Emergency room rates at CommonSpirit Front Range facilities are 45 % higher than all other nearby health systems.
- CommonSpirit’s St Anthony Summit Hospital in Frisco is the most expensive hospital in the state.
CommonSpirit leadership says Anthem’s suggested reimbursem*nt rates are simply too low, and they are asking for a rate that accounts for inflation.
“Our ongoing, good-faith negotiations aim to safeguard patient care and protect their choice of doctors by keeping our healthcare services in-network for Anthem members,” part of CommonSpirit’s online statement reads. “... Some patients may be forced to travel great distances to receive care – especially specialized care – and our ability to treat underserved or underinsured patients in low-income communities will be jeopardized.”
CommonSpirit says emergency care will not be impacted because laws require patients only be charged in-network rates for life-saving care, regardless of the provider’s status with the insurer.
However-- patients needing continued care are potentially the most vulnerable.
If CommonSpirit is no longer in network with Anthem, CommonSpirit says there is a two-week window that will allow surgeries to be covered by Anthem’s in-network rate. After that, patients insured by Anthem seeking continued care with CommonSpirit will be able to fill out forms to see if they qualify for being an exception to the new rule.
According to CommonSpirit leaders, they will advocate as best they can to keep as many patients as possible at in-network rates by making a case to Anthem that those patients need care continued with the same provider. But-- Anthem will have the final say in who qualifies for a continuum of care and who does not, which could be when patients are told to find a new Anthem in-network provider.
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